What is the procedure for treating superficial basal cell carcinoma using curettage?

From the Guidelines

Curettage is a recommended procedure for treating superficial basal cell carcinoma, particularly for low-risk lesions less than 2 cm in diameter on non-facial sites, with cure rates of 90-95% when performed correctly. The procedure involves scraping away cancerous tissue followed by electrodesiccation, and is typically performed in an office setting with local anesthesia administration, usually 1-2% lidocaine with epinephrine injected around the tumor site 1.

Procedure Details

• The physician uses a curette to scrape away the tumor tissue, which is softer than surrounding healthy skin.
• After initial curettage, electrodesiccation is performed using an electrosurgical device to destroy any remaining cancer cells and control bleeding.
• This scraping and cauterizing process is typically repeated for a total of 2-3 cycles to ensure complete tumor removal.
• The wound is then cleaned and dressed appropriately, with healing occurring by secondary intention over 4-6 weeks.

Important Considerations

• Curettage is less effective for lesions on terminal hair-bearing skin, such as the scalp, pubic, and axillary regions, and the beard area in men, due to the risk of follicular extension of the tumor 1.
• The procedure may be associated with a longer healing time and inferior cosmetic outcome compared to standard excision, and is best avoided in cosmetically sensitive areas 1.
• Patients should keep the wound clean, apply prescribed antibiotic ointment, and protect the area from sun exposure during healing.
• Follow-up appointments are necessary to monitor for recurrence, typically at 3,6, and 12 months post-procedure.

Evidence-Based Recommendations

• The American Academy of Dermatology recommends curettage as a treatment option for low-risk basal cell carcinoma, with a strength of recommendation of A and a quality of evidence of II-iii 1.
• The National Comprehensive Cancer Network (NCCN) also recommends curettage and electrodesiccation as a treatment option for superficial basal cell carcinoma, with a 5-year cure rate of 91-97% in selected patients 1.

From the Research

Procedure for Treating Superficial Basal Cell Carcinoma using Curettage

The procedure for treating superficial basal cell carcinoma (sBCC) using curettage involves several steps:

• Curettage is a surgical technique used to remove the tumor tissue from the skin 2.
• The procedure typically starts with the removal of the tumor tissue using a curette, a spoon-shaped instrument 3.
• The curetted material is then examined to confirm the diagnosis and to assess the margins of the tumor 3.
• In some cases, curettage may be followed by other treatments, such as imiquimod 5% cream, to enhance the efficacy of the treatment [(4,5)].
• The wound is then allowed to heal, and follow-up visits are scheduled to monitor the patient's progress and to check for any signs of recurrence 2.

Efficacy of Curettage for Superficial Basal Cell Carcinoma

Studies have shown that curettage is an effective treatment for sBCC, with high clinical clearance rates and short wound healing times 2.

• A prospective, randomized, and controlled trial found that curettage had a clinical clearance rate of 95.7% after 1 year, compared to 100% for cryosurgery 2.
• Another study found that preoperative curettage may be helpful in delineating BCC margins, especially in nodular and superficial BCC 3.

Combination Therapy with Imiquimod

Curettage can be combined with imiquimod 5% cream to enhance the efficacy of the treatment [(4,5)].

• A pilot study found that curettage followed by imiquimod 5% cream was effective for the treatment of primary nodular basal cell carcinoma, with a histological clearance rate of 94% 4.
• Another study found that imiquimod 5% cream as adjunctive therapy to curettage and electrodesiccation reduced the frequency of residual tumor and improved the cosmetic appearance 5.